Overdiagnosis in psychiatry
and refuse to work.’ This example clearly demonstrates how Cartwright has over diagnosed here - instead of viewing their revolt and disobedience as an argument against slavery he characterized it as a mental health disorder. The study also argues how this sense of prejudice is continued up to now; it states, ‘since the 1970s to the present, international studies have shown overdiagnosis of schizophrenia in African American, Afro Caribbean and [Hispanic communities ].’ The reasons for this are clinician prejudice and a lack of contextual diagnosis; the former being that clinicians could view those of colour as ‘simpler’ and ‘emotionally unstable’, the latter meaning that a generic standard is used to assess patients instead of understanding individual circumstances to make an informed decision. This study implies that physicians have shown to be employing prejudices and stereotypes to make overdiagnoses in mental health, particularly towards BAME groups. Healthcare professionals have only recently beenmade aware of the effects of overdiagnosis, and many studies have been run to show how it detrimentally effects an individual, particularly within mental health; one case looks at the overdiagnosis of ADHD. The BMJ conducted research into what is described as ‘enthusiastic diagnosis’ of ADHD in children and concluded that it can cause severe harm to children with mild symptoms (Thomas et al., 2013). This is because children often take medication like Ritalin, which is not necessary, furthermore overdiagnosis undermines the value of the diagnosis that children with more severe symptoms have. It describes results showing that prescribing rates of ADHD-related medicines like methylphenidate and dexamphetamine have increased by 72.9% from 2000 to 2011 and pinpoints the cause for this drastic rise as ‘shifting definitions’. This is because several different criteria are used for diagnosis, those being the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) . These have been used interchangeable, resulting in different definitions of what ADHD looks like. For example. The DSM has changed the number of symptoms required for diagnosis several times over its various issues, going from 8 to 12 to 12/10 (depending on the age of the patient). This inconsistency in diagnostic standards means it is more difficult for psychiatrists to distinguish between those with the disorder and those without, and this lack of certainty can lead to a break down in the doctor-patient relationship. This is caused by mis- /overdiagnosis of ADHD by a doctor, causing the patient to lose trust in their doctor’s opinion, then either seeking alternative counsel or disengaging from the healthcare system altogether. The breakdown of the doctor-patient relationship is one of themain effects of overdiagnosis, and whilst it may not directly affect patients, this issue causes a general lack of trust in doctors and their ability to make informed decisions. Whilst autonomy – the patient’s power to choose their own course of treatment – is still valued as one of the pillars of medical ethics today, the patient’s autonomy can only be successful if the patient is fully informed of all factors and information. In a situation where over- /misdiagnosis has happened, and this relationship has broken down, the patient feels they can no longer trust their clinician’s opinion, and thus makes a decision without being told of the different factors the doctor has observed. This may have serious consequences coming onto more severe decisions which need to be made. A previously mentioned article looked at the feelings of mistrust between certain groups and their clinicians, specifically Hispanic and African American communities. In a study taken by the Commonwealth Fund 2001 Health Care Quality Survey, 18% of Hispanic Americans, 16% of African Americans and 13% of Asian Americans said they felt disrespected by healthcare professionals on account of their race or ethnicity (Suite et al., 2007). Furthermore, 15% of African Americans, 13% of
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